Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Τρίτη 15 Νοεμβρίου 2022

Black and White Patients with Staphylococcus aureus Bacteremia have Similar Outcomes but Different Risk Factors

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Abstract
BACKGROUND
Staphylococcus aureus bacteremia (SAB) disproportionately affects Black patients. The reasons for this disparity are unclear.
METHODS
We evaluated a prospectively ascertained cohort of patients with SAB from 1995 to 2020. Clinical characteristics, bacterial genotypes, and outcome were compared among Black and White patients with SAB. Multivariable logistic regression models were used to determine factor s independently associated with the outcomes.
RESULTS
Among 3068 patients with SAB, 1107 (36%) were Black. Black patients were younger (Median: 56 years vs. 63 years; p < 0.001), had higher rates of diabetes (47.5% vs. 34.5%; p < 0.001), hemodialysis dependence (40.0% vs. 7.3%; p < 0.001), and HIV (6.4% vs. 0.6%; p < 0.001). Black patients had higher rates of methicillin-resistant S. aureus (49.3% vs 44.9%; p = 0.020), including the USA300 hypervirulent clone (11.5% vs. 8.4%; p = 0.007). White patients had higher rates of corticosteroid use (22.4% vs. 15.8%; p < 0.0001), and surgery in the preceding 30 days (28.1% vs. 18.7%; p < 0.001). Although median Acute Physiology Score (APS) at the time of initial SAB diagnosis was significantly higher in Black patients (Median APS 9, Interquartile Range [IQR] 5-14; vs. Median APS 7, IQR: 4-12; p < 0.001), race was not associated with 90-d ay mortality (risk ratio (RR): 1.02; 95% CI: 0.93–1.12, and rates of metastatic infection were lower among Black patients (37.2% vs. 41.3% White; p = 0.029).
CONCLUSIONS
Despite differences in Black patients' higher APS on presentation and more risk factors, including a 5 times higher risk of hemodialysis dependence, 90-day mortality among Black and White patients with SAB was similar.
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High cytomegalovirus viral load is associated with 182-day all-cause mortality in hospitalized people with human immunodeficiency virus (PWH)

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Abstract
Background
Cytomegalovirus (CMV) infection is associated with increased mortality in PWH. It is less clear whether CMV infection is still associated with mortality when routinely screened and adequately treated.
Methods
This retrospective cohort study recruited 1003 hospitalized HIV-infected adults with CD4 cell counts of less than 200 cells/μL from 2017-2021. Blood CMV DNA was routinely measured and CMV DNAemia was treated if end-organ disease occurre d. CMV viral load was categorized into below the limit of quantification (BLQ;  < 500 IU/mL), low viral load (LVL; 500-10000 IU/mL), and high viral load (HVL;  ≥ 10000 IU/mL) groups. We compared the 182-day all-cause mortalities among different groups.
Results
The median CD4 cell count of the patients was 33 cells/μL (IQR, 13-84). The prevalence of CMV DNAemia was 39.8% (95%CI, 36.7%-42.9%) and was significantly associated with CD4 cell count. The 182-day all-cause mortality was 9.9% (95%CI, 8.0%-11.7%). Univariable analysis showed that, compared to BLQ, LVL and HVL were associated with 1.73-fold and 3.81-fold increased risks of mortality, respectively (P = 0.032 and P < 0.001). After adjustment for pre-defined confounding factors, HVL but not LVL was still associated increased risk of mortality (adjusted hazard ratio 2.63; 95%CI, 1.61-4.29; P < 0.001). However, for patients on effective anti-retroviral therapy, the impact of HVL on 182-day mortality was not statistically significant (P = 0.713).
Conclusions
High CMV viral load in hospitalized PWH was associated with higher mortality, even when early identified by screening. Optimalization of the management for those patients needs to be explored in future studies.
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Management of drug-drug interactions between long-acting cabotegravir and rilpivirine and comedications with inducing properties: a modelling study

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Abstract
Background
Long-acting (LA) intramuscular cabotegravir and rilpivirine are prone to drug-drug interactions (DDI). However, given the long dosing interval, the conduct of clinical DDIs studies with LA antiretrovirals is challenging. We performed virtual clinical DDI studies using physiologically based pharmacokinetic (PBPK) modelling to provide recommendations for the management of DDIs with strong or moderate inducers such as rifampicin or rifabutin.
Methods< /div>Each DDI scenario included a cohort of virtual individuals (50% female) between 20-50 years of age with a body mass index of 18-30 kg/m2. Cabotegravir and rilpivirine were given alone and in combination with rifampicin or rifabutin. The predictive performance of the PBPK model to simulate cabotegravir and rilpivirine pharmacokinetics after oral and intramuscular administration and to reproduce DDIs with rifampicin and rifabutin was first verified against available observed clinical data. The verified model was subsequently used to simulate unstudied DDI scenarios.
Results
At steady-state, the strong inducer rifampicin was predicted to decrease the area under the curve (AUC) of LA cabotegravir by 61% and rilpivirine by 38%. An increase in the dosing frequency did not overcome the DDI with rifampicin. The moderate inducer rifabutin was predicted to reduce the AUC of LA cabotegravir by 16% and rilpivirine by 18%. The DDI with rifabutin can be overcome by admi nistering LA cabotegravir/rilpivirine monthly together with a daily oral rilpivirine dose of 25 mg.
Conclusion
LA cabotegravir/rilpivirine should be avoided with strong inducers but coadministration with moderate inducers is possible by adding oral rilpivirine daily dosing to the monthly injection.
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Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow‐up period of at least 5 years: A systematic review and meta‐analysis

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Abstract

Background

Zygomatic implants (ZI) have been frequently indicated to rehabilitate patients with extensive atrophies in alternatives to major bone reconstructions. It can be installed inside the maxillary sinus, called instrasinus zygomatic implant (IZI) or outside the maxillary sinus (EZI), depending on the surgery technique.

Objective

To evaluate the survival and complication rates of ZI in longitudinal studies when compared with conventional implants (CI).

Methods

An electronic search was performed in five databases and in Gray literature for articles published until April, 2022. The eligibility criteria comprised observational cohort studies (prospective or retrospective) and randomized clinical trials (RCTs) with at least 5 years of follow-up, reporting survival rate of ZI versus CI. A meta-analysis was conduct with 18 studies.

Results

A total of 5434 implants (2972 ZI and 2462 CI) were analyzed in 1709 patients. The mean survival rate was 96.5% ± 5.02 and 95.8% ± 6.36 for ZI and CI, respectively (mean follow-up time of 78 months). There were observed no statistically significant between ZI and CI in prospective studies (risk ratio [RR] of 1.21; 95% confidence intervals [CIs]: 0.28 to 5.28; chi-squared [Chi2] = 11.37; I 2 = 56%; degrees of freedom [df] = 5; z-score = 0.25; P = 0.80), retrospective studies IZI (RR of 1.29; 95% CIs: 0.52 to 3.23; Chi2 = 4.07; I 2 = 2%; df = 4; z-score = 0.55; P = 0.58) and retrospective studies EZI (RR of 0.72; 95% CIs: 0.31 to 1.66; Chi2 = 1.99; I 2 = 0%; df = 3; z-score = 0.78; P = 0.44). The biological complications most related to ZI was sinusitis, followed by infection and oroantral communication.

Conclusion

ZI have a high long-term survival rate (96.5% with a mean of 91.5 months of follow-up), showing no significant difference when compared with CI. The most prevalent biological complication is sinusitis, being most commonly to the IZI technique. This systematic review (SR) was registered in INPLASY under number INPLASY202280025.

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A Prospective Study of BurstDRTM Spinal Cord Stimulation for non‐Operated Discogenic Low Back Pain

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Abstract

Introduction

Chronic discogenic low back pain (CD-LBP) is caused by degeneration of the disc due to trauma to the annulus or by unprovoked degeneration, resulting in chronic pain. Spinal cord stimulation (SCS) employing the BurstDRTM waveform has been shown to be an effective treatment in a variety of chronic pain conditions. The aim of this prospective case study was to determine the effect of BurstDRTM SCS on pain relief, disability, and patient satisfaction in a population with CD-LBP.

Methods

17 subjects with CD-LBP received a SCS trial with BurstDRTM stimulation. Patients with >50% pain relief after a trial period of 2 weeks were permanently implanted (n=15). Patients then rated LBP and leg pain using the numeric rating scale (NRS), Oswestery disability index (ODI), patient global impression of change (PGIC), EQ-5D quality of life and paindetect for neuropathic pain at baseline following trial, 3, 6 and 12 months after permanent implantation.

Results

Treatment with BurstDRTM SCS resulted in significant reduction of LBP as the NRS was reduced from 71.7± 7.3 at baseline to 42.5 ± 18.1 at 12 months. Average pain relief at 12 months was 42.5%. In patients with leg pain (n=8), pain was significantly reduced from 66.9 ± 8.2, to 11.7 ± 10.4 at 12 months. PainDETECT scores for neuropathic pain significantly reduced from 18.9 ± 4.8 at baseline, and 14.8 ± 3.2 at 12 months. Baseline ODI score significantly reduced from 41.2 ± 12.8, to 25.8 ± 8.6 at 12 months. PGIC scores remained low from 2.6 ± 1.6 at 3 months, 2.5 ± 1.0 at 6 months and 2.5 ± 1.3 at 12 months. EQ-5D-5L rates remained constant from baseline 56.10 ± 23.9 to 68.6 ± 12.9 at 12 months.

Conclusion

BurstDRTM SCS resulted in significant reduction of back pain, leg pain and quality of life in patients with CD-LBP and decreased the level of disability and generated positive patient satisfaction scores..

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Efficacy of chemical approaches for implant surface decontamination in conjunction with sub‐marginal instrumentation, in the non‐surgical treatment of peri‐implantitis. A systematic review

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Abstract

Aim

To answer the PICOS question: in adult patients with peri-implantitis, what is the efficacy of sub-marginal instrumentation combined with chemical surface decontamination in comparison with sub-marginal instrumentation with or without placebo, in terms of changes in probing depth (PD) and/or bleeding on probing (BOP), as reported in prospective randomized controlled trials, nonrandomized controlled trials or prospective cohort studies, with a minimum of 6-month "follow-up".

Materials and methods

A systematic literature search was performed in: PubMed, Web of Science (WOS), Embase, Scopus, Ovid Medline and The Cochrane Library of the Cochrane Collaboration (CENTRAL) for articles published until March 2022. Data addressing the primary and secondary outcomes were extracted.

Results

The search gave 2033 results of which three studies fulfilled the inclusion criteria. Two studies investigated the use of antimicrobial photodynamic therapy as adjunct to submarginal instrumentation and the third study assessed the adjunctive use of a desiccant material. A meta-analysis was not deemed meaningful due to the large heterogeneity among studies. All three studies showed favourable results in terms of PD reduction for chemical surface decontamination over control approaches, but were inconsistent or showed no differences for the other outcome variables.

Conclusions

Adjunctive chemical approaches for implant surface decontamination may offer an advantage over sub-marginal instrumentation alone, in terms of improved PD.

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Diagnostic Criteria for Temporomandibular Disorders − INfORM recommendations: Comprehensive and short‐form adaptations for children

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Abstract

Background

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed.

Objective

To present comprehensive and short-form adaptations of Axis I and II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings.

Methods

Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children.

Results

The proposed adaptation is suitable for children aged 6−9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire, and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, and (ii) adding anxiety and depression assessments that have been validated in children, and (iii) adding three constructs (stress, catastrophizing, and sleep disorders) to assess psychosocial functioning in children.

Conclusion

The recommended DC/TMD, including Axis I and Axis II, for children aged 6−9 years, is appropriate for use in clinical and research settings. This adapted first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

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Accurate occlusion-driven maxillary reconstruction with deep circumflex iliac artery flap using computer-assisted techniques and intraoral anastomosis: a case series study

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The aim of this study was to evaluate the feasibility and accuracy of occlusion-driven maxillary reconstruction with the deep circumflex iliac artery (DCIA) flap, using computer-assisted design and manufacturing (CAD/CAM) technology and intraoral anastomosis. The data of 11 patients who underwent occlusion-driven maxillary reconstruction with this method between December 2018 and December 2020 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology were reviewed retrospectively. (Source: International Journal of Oral and Maxillofacial Surgery)
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Full arch immediate occlusal loading using site specific implants: a clinical series of 10 patients (13 arches)

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Abstract

Purpose

Osseointegration of dental endosseous implants has proven to be effective, predictable, and clinically successful. Unloaded healing protocols were originally used in treating edentulous patients. Full arch immediate occlusal loading protocols have been shown to be as effective as unloaded healing protocols. This paper reports on the results, benefits, and limitations of one specific immediate loading protocol using site specific implants for fresh extraction and healed extraction sites.

Materials and Methods

Ten consecutive patients [{13 arches} (age range: 64–81 years; average: 70.1) (4 males/6 females) were treated by the first 2 authors in private practice settings. Hopeless teeth were scheduled for extraction with immediate implant placement and immediate loading with insertion of full arch, screw-retained, acrylic resin interim prostheses within 24 hours. Implants were also placed into healed edentulous ridges. Insertion torque values for each implant were recorded. Interim prostheses were removed after at least 3 months of healing. Implants were reverse torque tested (35Ncm) and evaluated for macroscopic mobility. Definitive full arch prostheses were made. Patients were followed for 21- 48 months post implant surgery. Panoramic radiographs were taken immediately post implant placement and one year post operative.

Results

Thirteen arches were treated; 11 ultrawide diameter implants were placed into molar sockets, 26 inverted body-shift implants were placed into anterior sockets; 25 standard diameter, tapered implants were placed into edentulous sites; 2 zygomatic implants were placed in one patient. The total number of implants placed was 64 (4 pre-existing implants were also used and not included in this study). The minimum implant insertion torque value was 20Ncm. After 12–18 months of function (average 14 months), the implant and prosthetic survival rates were 100%. Eight patients were restored with definitive zirconia or acrylic resin hybrid fixed prostheses. Two patients were restored with bar titanium frameworks and removable overdenture prostheses. No prosthetic complications were reported for the definitive prostheses.

Conclusions

The results of this clinical series with site specific implants and immediate full arch occlusal loading in treating edentulous patients resulted in 100% clinical implant and prosthetic survival rates. According to this study, this protocol can be used with high levels of anticipated success.

This article is protected by copyright. All rights reserved

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Gastrectomy Versus Esophagectomy for Gastroesophageal Junction Tumors: Short- and Long-Term Outcomes From the Dutch Upper Gastrointestinal Cancer Audit

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imageObjective: Investigate long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for gastroesophageal junction (GEJ) cancer. Background: Both a total gastrectomy and an esophagectomy may be valid treatment options in patients with GEJ cancer. Which procedure results in the most optimal patient outcome is not well studied. The aim of this study was to investigate the long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for GEJ cancer. Methods: A retrospective comparative cohort study of prospectively collected data from the Dutch Upper GI Cancer Audit combined with survival data of the Dutch medical insurance database was performed. Patients with GEJ cancer in whom a total gastrectomy or an esophagectomy was performed between 2011 and 2016 were compared. The primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, radicality of resection, and lymph node yield were secondary endpoints. Results: A total of 871 patients were included: 790 following esophagectomy and 81 following gastrectomy. The 3-year overall survival was 35.8% after esophagectomy and 28.4% after gastrectomy (hazard ratio 1.2, 95% confidence interval 0.721–1.836, P = 0.557). Postoperative morbidity, mortality, radicality of resection, lymph node yield, and 3-year conditional survival did not differ significantly between groups. Conclusion: A total gastrectomy and an esophagectomy for GEJ cancer show largely comparable results with regard to long-term survival, postoperative morbidity, mortality, and pathology results. If both procedures are feasible, other parameters such as surgeon's experience and quality of life should be considered when planning for surgery.
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